Breast Reconstruction

After a Mastectomy

We want you to be informed about your options so that you can have the best possible outcome throughout your journey with cancer. The following questions and answers we hope will guide you through the process when considering breast reconstruction following a mastectomy. 

Q: What is breast reconstruction?

A: Breast reconstruction is surgery to rebuild a breast that was removed to treat or prevent cancer. Reconstruction can be done using implants or using tissue taken from other parts of your body, called “flaps.”

If you are planning to have surgery to remove a breast (mastectomy) make sure to talk to your surgeon about reconstruction before your procedure. Your mastectomy might need to be done in a certain way for you to be able to have the type of reconstruction you want. Ask your doctor about Hidden Scar Breast Cancer Surgery, an advanced approach to breast cancer surgery in which the surgeon will place the incision in a location that is hard to see so that the scar is not visible when your incision heals. 

Q: Do I need breast reconstruction after a mastectomy?

A: This is a personal decision. You do not have to have breast reconstruction. However, it has been shown to be psychologically beneficial and improve women's quality of life when they have their breast reconstructed. It also helps clothing fit better. This is why the government has mandated that breast reconstruction be completely covered by insurance. However, if a women does not wish to undergo any reconstruction that is an acceptable option for her as well. 

Q: When can I have my breast reconstructed?

A: Breast reconstruction can be done at the time of a mastectomy or later. The timing for you will depend on the stage of your cancer and what other treatments you need. Also, if you want to delay reconstruction for personal reasons, you can ask your doctor about doing that.

Women with early-stage cancer or who are having a mastectomy to prevent cancer can have reconstruction done at the same time. This is called “immediate reconstruction.” The skin that is left after a mastectomy can be used like a pocket to hold the tissue that will make up the new breast.

Women with late-stage or large cancer sometimes need to have radiation therapy after a mastectomy. Radiation therapy is a treatment that kills cancer cells. These women sometimes need to delay reconstruction until radiation treatment is finished. This is one type of “delayed reconstruction.” The delay is needed because the reconstructed breast could keep radiation from reaching the right areas or be damaged by the radiation.

Q: Will my new breast match my other breast?

A: As much as possible, yes. However, the new breast will not be like the one you had before or like the other breast. Plus, you won’t have normal feeling (sensation) in the new breast. Your surgeon might need to operate on your healthy breast to make the two breasts look as similar as possible.

Q: What are the different ways that surgeons can reconstruct a breast?

A: The two main ways are with implants or with flaps. There are several kinds of flaps, each named for the muscles they are made of. The best reconstruction approach for you will depend on:

  • How big your breasts are to begin with
  • How much extra body fat you have and where
  • Whether you smoke, are overweight, or have health problems, such as diabetes, or heart or lung disease
  • Whether you have had surgery before and on what part of your body, because scars might affect which tissue can be used
  • Whether you have had radiation therapy. Radiation may affect your options for breast reconstruction. It can also raise the risk of problems if it's given after reconstruction. 

Q: How does reconstruction with an implant work?

A: A breast implant is basically a breast-shaped container that is filled with salt-water (called “saline”) or something that feels like Jell-O (called “silicone”). The implant is inserted under a layer of muscle in the chest.
Getting an implant usually involves two steps. First, the surgeon inserts a device called an “expander.” This device stretches the skin and muscle in the chest, so that they can hold the implant. Doctors gradually add more and more fluid to the expander until the skin and muscle are stretched enough for the implant. Then, the surgeon does another surgery to insert the implant. Implants are best for women with smaller breasts that don’t droop.

Q: How does reconstruction with a flap work?

A: That depends on which type of flap is used. The most commonly used flaps are:

TRAM flaps – A TRAM flap is taken from the belly and is made up of skin, fat, and muscle. When the muscle in the flap stays attached to the blood vessels that supply it, it is called a “pedicled TRAM flap”. This type of flap is tunneled under the skin from the belly to the new breast pocket.

When the flap is completely disconnected from the belly and its blood vessels, it is called a “free TRAM flap”. This type of flap is attached to a new set of blood vessels in the chest. It doesn’t stay connected, so it does not have to be tunneled to its new location.

Both kinds of TRAM flaps can be done only in women who have enough belly fat to make a flap. After surgery, the belly looks flatter, like it does after a “tummy tuck.” Women who have this type of flap have a scar along their bikini line from hip to hip.

Lat flap – A Lat flap is taken from the back and is made up of skin, fat, and muscle. The flap stays attached to its own blood supply and is tunneled under the skin from the back to the chest. Women who have this kind of flap have a scar on their back beneath the bra line. They also often get an implant, because there is not enough fat on the back to make a new breast.

DIEP flap – A DIEP flap is taken from the belly, but it is different from a TRAM flap because it is made up of skin and fat but NOT muscle. Connecting these flaps to a good blood supply is harder than it is for other flaps. That means the surgery can be more complicated and take longer.

Flaps taken from other places – Women who do not have enough belly fat to make good TRAM or DIEP flaps can have flaps taken from other parts of their body. For instance, doctors sometimes take flaps from the rear end or inner thigh